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Welcome to the Postural Restoration Community! This is where you will read the latest industry news, hear about upcoming events, find helpful deadline reminders, and view a plethora of additional resources regarding our techniques and curriculum. The great part about it is--not only can you can view the entries we post, you can also post about the things that matter to you. Did you find an interesting article about a technique you learned in one of your courses? Do you have a patient case study you want to share with other professionals? Simply click "Submit an Entry" and follow the easy steps towards getting your information published in the PRI Community!

Blog Posts in January 2016

ATLANTA!!! Finally!!! Georgia hosts the first PRI course in history. Granted, I have hosted courses in my clinic here in the Peach State before but this was different. This Myokinematics course was hosted by a totally separate organization. I'd like to thank Liz Billeter DPT of Sovereign Physical Therapy for being such a great host and Alan Grodin PT, MTC for sending his troops to this first installment of their PRI journey. We had a great time in spite of the crazy weather and I had a lot of fun with this outstanding group. Thanks Eric Oetter SPT for lab assisting and a special thanks to Adrian Baker DPT, PRC for her behind the scenes work and lab assisting. The two of you are very special to me. Here's to another Atlanta course soon!!!!

Improper shoe wear can quickly defeat a PRI program. Conversely the correct shoe wear can have dramatic positive effect on a program. Whether the patient needs more control of their heel bone and midfoot, or sensory guidance for proper gait mechanics, or cushion to sense the foot's impact on thier body, the correct shoe can make all the difference. The inability to “sense” the floor makes it a challenge for a PRI therapist to successfully progress their PRI program. This is often caused by compensation from faulty foot mechanics and improper shoe wear. The ability to “sense” the floor and move with appropriate patterns of muscle activity is enhanced when proper footwear is provided to allow adequate support to obtain a functional position. The Hruska Clinic® recommended shoe list is reviewed and updated annually to provide individuals with choices of shoes that promote a successful PRI integrative program.

PRI Vision Integration for the Baseball Player always takes me to warm places, which is never a disappointment to me, especially during Nebraska winters! Last weekend was no exception, with Phoenix temps in the 60s, sunshine, and no wind; paradise, even for such a quick trip.
There are several reasons I love teaching this course. One of them is the people that attend. Jimmy Southard, of the Mariners, and his colleagues did a fantastic job hosting and being gracious enough to be frequent volunteers for the demos. Additionally, since Jimmy and a few others had taken this course the first time it was taught over a year ago, they were able to shed some light of personal experience on the room, which is always invaluable for other attendees. We were also fortunate to have attendees from Korea and Japan with us, plus both US coasts. The room was a great mix of athletic trainers, therapists and strength coaches from different professions and backgrounds, not just baseball, which always sparks discussions of further and alternative applications of the concepts. I feel the more discussion and group participation we have in a room, the more everyone, including this speaker, grows from the experience.
The other major reason I love this course is that it’s a day where you can be very new to PRI or seasoned with many years experience and certification behind your name, and you leave looking at every person’s behavior, as evidenced through physical performance and habits, a little differently. I have often been told that this course is a great introduction to vision concepts for physical application, since it’s designed for those who have little or no PRI background even though it is based on core PRI principles. Having fun showing some “magic” with how someone can change if/how strong they can feel a muscle activating by consciously changing how they visually look at their environment is something I truly love. Then to be able to assess the impact of other sensory input, such as how a baseball feels in a player’s hand, (or doesn’t feel when you wrap some athletic tape around it), and use these tools to help players not only get better, but get in a better position to perform with less physical stress, is just the fulfilling finish to an incredible day.
Thanks to all the attendees and hosts!
Keep Moving Beyond Sight,
Dr. Heidi
PS—If you’ve never seen a Phoenix sunset, you should

The following article was inspired by the book, The Brain’s Sense of Movement by Alain Berthoz and the concepts taught by the Postural Restoration Institute (PRI). The purpose of this narrative is to explore the multisensory nature of PRI.

Traditionally, we presume that the goal of our PRI interventions is to create postural changes and thus function via first repositioning to achieve positional and neuromuscular neutrality by decreasing the dominant L AIC/R BC/R TMCC lateralized pattern, followed by retraining the body to be able to fully appreciate the submissive R AIC/L BC/L TMCC pattern, and finally restoring authentic reciprocal alternation between the two. This ultimately means the ability to walk and breathe utilizing all 3 planes of motion as well as have the movement variability capacity to experience other potential functional strategies of these synergistic patterns such as sports performance activities or simply carrying an object while walking.

Within this paradigm, we tend to think about inhibiting specific chains of muscle (members of the L AIC/R BC/R TMCC) while facilitating the opposing R AIC/L BC/L TMCC neuromuscular synergistic pattern. More details of these chains and their composition can be found at https://www.posturalrestoration.com/the-science. Depending on an individual’s specific patterns and where they are in their restorative process, some of these chains and plane of function (meaning sagittal, frontal, and transverse) may need to be emphasized more than others. However, the bottom line is that PRI practitioners are mainly considering within their treatment rationales which chain(s) of these synergistic patterns of neuromuscular function need to be inhibited/facilitated and the corresponding plane of emphasis. Again, this is all for the goal of efficient and effective movement.

In my recent previous article (http://www.posturalrestoration.com/community/post/2633/biasing-bilateralism-with-unilateral-sensory-and-manual-integration-by-heather-carr?id=2633), I discussed the interrelated somatosensory nature of neuromuscular function. This means that the brain is programmed not only to simply facilitate or inhibit various agonistic and antagonistic chains of muscle but that this mechanism is accompanied by the ability to also sense and feel these contractions, accompanying body segment positions, and movement relative to each other. To be more specific, our somatosensors (such as tactile, proprioceptive, and kinesthetic receptors) are feeding the brain information regarding position, velocity, and acceleration. In PRI, we refer to these as reference centers. PRI teaches 6 key ones (as described in the Impingement and Instability course) that when one has the ability to sense they most likely can also simultaneously engage the corresponding desired neuromuscular chains and hence movement patterns for better function and performance. The brain does not aim to separate motor from tactile, proprioceptive, and kinesthetic processing but needs all of this information for proper motion. In cases where there is impairment here, such as with a stroke or peripheral neuropathy, movement capability can become significantly dysfunctional.

Let’s take this a step further. When processing somatosensory signaling, the brain concurrently needs other sensory signals that are crucial for desired movement goals. This includes vestibular, visual, and auditory reception and thus perception. The vestibular receptors provide critical information to the brain such as where the head is oriented with respect to gravity, its velocity and acceleration, as well as the plane of its motion. In fact, the semicircular canals are organized in 3 perpendicular planes with one another which enables the differentiation between sagittal, transverse, and frontal vectors of head movement. This triplanar architecture is reflected in the subcortical areas where the 3 dimensional directional information is retained and further integrated with visual, auditory, and somatosensory signals. Furthermore, muscles are represented in the brain by their “eigenvectors”, their own virtual vectors that convey the amplitude of force exerted by each muscle and its corresponding plane of action. There seems to exist patterns of redundancy with the orientation of the planes of the semicircular canals to how the brain processes 3 dimensional movement and position to enable more consistent sensory processing. For example, the three pairs of extraocular muscles are approximately parallel to the planes of the semicircular canals likely making it easier for the brain to reconcile triplanar multisensory information.

What is important to understand is that without the merging of ALL the sensory information, the brain will not be able to completely know its position and movement with respect to itself, the ground, and other objects. For example, without synchronized signals from both the visual the vestibular systems, the brain wouldn’t be able to tell whether the body and/or the environment is moving. Without appropriate integrated tactile, proprioceptive, and kinesthetic signaling, the brain has no idea where its body segments are positioned relative to the head and the ground. Without proper visual processing, the body loses information regarding orientation of the position of self with relation to the environment coupled with reduced direction, speed, and acceleration of movement signaling. Furthermore, the auditory system also provides information regarding environmental space as patterns of sound are detected and contribute to an individual’s orientation relative to their surroundings. In sum, postural positioning and movement with respect to the self, ground, and other objects is dependent on all of these sensory signals.

Not only do we need authentic sensory signaling from the vestibular, visual, auditory, and sensorimotor systems but this information must be perceived by the brain in a coherent manner. Thus the term, “neurosensory coherence,” describes this phenomenon. There are certain parts of the brain such as the superior colliculus, cerebellum, and lateral geniculate nucleus of the thalamus that are especially important for merging these signals together and communicating with around 20 other brain structures. In fact, these sensory pathways are so intertwined that some neurons can respond to different types of sensory receptor signals. For example, 2nd order vestibular neurons fire from both oculomotor and neck efferent signals as well as incoming afferent vestibular, visual, and proprioceptive signals. Some bimodal neurons can be fired with either visual or tactile input and thus can create the same perception. The visual stimulus of a finger moving to touch one’s face can be perceived as actually touching the face without real contact due to the overlapping tactile and visual receptor field function. Some cases of hemi neglect have shown that injection of cold water into the ear and thus stimulating the vestibular system can temporarily alleviate symptoms of neglect including hemianopsia (seeing only ½ of a visual field) and/or hemianethesia (reduced sensation on ½ of the body). Likewise, somatosensory stimuli (example of transcutaneous electrical-stimulation) as well as visual stimuli (such as prism glasses) can also reduce symptoms of neglect. What this means is that a somatosensory stimulus can simultaneously be perceived as a somatosensory, vestibular, or visual stimulus and vice versa. The somatosensory primary cortex seems to have no preference for the various sensory inputs. There are a variety of neurosensory patterns in the brain that can all contribute to neurosensory perception and body schema. Therefore, movement ultimately creates and requires a symphony of somatosensory, visual, vestibular, and auditory sensory signaling that must be properly synchronized, merged, and modulated together with other cortical and subcortical discharge. When this neurosensory coherence occurs, desired and efficient movement is permitted. Therefore, in cases where this is not occurring the clinical dilemma involves figuring out which sensory system(s) to manipulate to achieve the desired functional outcome.

Within the paradigm of PRI, we assume an inherent asymmetry and lateralization of the postural system. However, based on the information presented in this article, I hope you are now also assuming this includes an asymmetrical and lateralized sensory system. Once again, the brain merges all of this information together for processing posture and movement modulation. The brain is actually constantly checking to see if how it predicted position and motion was indeed perceived as accurate. Furthermore, this information is not just being used to only put us in certain positions and permit movement but also is concurrently telling us where we are located in space relative to the ground and peripheral environment. Movement is orientation and orientation is movement. For example, the brain regulates the firing threshold of a motor neuron. This threshold (meaning how easy or difficult it is to fire) is influenced by the position of the body part and thus also has a spatial dimension within it. Considering both the agonist and antagonist facilitation or inhibition tendencies (think PRI patterns), these thresholds convey spatial information because of their correlation to different body segment angles. This is one of the main principles that PRI non-manual techniques are based on. We are attempting to encode new threshold relationships between agonists and antagonists in synergistic patterns in specific positions which concurrently encode new spatial patterns with vestibular, visual, and auditory frames of reference.

To help understand this concept even more, wherever you are right now pause to do the following: Acknowledge the position you are in and how this feels. For example, if you are sitting where do you and don’t feel pressure? What angles are your body segments at? Can you sense whether your body is leaning or rotated in a particular direction? Are you moving? Are you on an object that is moving (car) or are you moving on an object (walking on the ground)? Are objects moving around you (cars or people)? What sounds do hear? Are they coming from far or near? Now for the punchline: ALL of what you just experienced, including what you see and hear is YOU. Not only is your body but also what you perceive beyond your personal space is YOU. It is YOUR NEUROSENSORY WORLD. The question then becomes: is your neurosensory world coherent on both sides of not only your body but also SPACE which includes the visual and sound fields?

If you exist in a lateralized body and world, you therefore not only posture and move differently on each side but you also perceive space such as the ground, gravity, objects, and sound asymmetrically as well. PRI practitioners are typically trying to teach our patients and clients to position and move in new ways to become less lateralized. However, in reality we are also simultaneously teaching them a new orientation and perception of space. Therefore, when you are working with your patient or client, try to imagine their entire neurosensory world (as you just practiced) and perceived reality. This “imagination” of neurosensory perception is what Ron Hruska bases his neurosensory decision making recommendations on. He interacts with patients to figure out how best to modulate their neurosensory world to achieve authentic reciprocal alternating body and space coherence.

In conclusion, the L AIC/R BC/R TMCC dominant pattern promotes a neurosensory illusion of being half lost in space and body. Therefore, when you are instructing your patients and clients in a PRI technique, consider not just the specific muscles and plane you are trying to inhibit or facilitate but also the corresponding sensory pieces to them. Many of these aspects are already in the techniques whether you realized it or not. Basically, any time you reposition the postural system you are concurrently reorienting its perceived space. Consider what other sensory mediums you can use to achieve this. This is why the Postural-Visual Integration course is so powerful because it emphasizes the visual aspect of our space which is a huge piece of our neurosensory world. I am really looking forward to learning how the auditory system can be engaged to instill coherent space and body function at this spring’s annual symposium…….

This was my first time in Austin and at STAR Physical Therapy. The host site and facilities were exceptional. The clinic is a total reflection of what we do in PRI. It was great having Mike validating terminology, process of examination, treatment, and clinical application. His ability to explain this course’s application will be very helpful for any course attendee who takes this course. The course also gave me the personal opportunity to learn what was meaningful to experienced PRI PTs, strength coaches, and ATCs. I want to have a special shout out to Eric Broberg, DDS who stuck with me both days to give input on the material as it relates to cervical orientation. This weekend of validation and confirmation was hopefully realized by all attendees to help realize when to use dentistry in the treatment of patients with neck dysfunction.

Excitement is the word that comes to mind as I reflect on the time I had at Seattle Mariners spring training facility in Phoenix, AZ. The class was excited because we finally moved to secondary level course material and could really elaborate on specific neurological references that rule the day when dealing with athletes and patients. Questions were thoughtful and truly advanced. Establishment of frontal plane control was closely assessed and we closely examined the varying areas of common impingement sites. Did you know that humans actually LOVE to impinge? How can we fix an impingement when the patient doesn't want to? There are multiple opportunities to enroll in this life-changing course so don't miss out! Jimmy Southard thank you so much for your kindness and your hospitality. Looking forward to returning for more my friend!

Enjoyed a great weekend at the Peoria Sports Complex with a super group of baseball professionals building our knowledge and expanding our perspective on how to care for the overarm rotational athlete. A big thank you to Jimmy Southard for being a great host and the consummate professional.

Common human postural patterns as related to the pelvis and thorax were presented and discussed. The compensatory rotational patterns that commonly develop with overarm rotational athletics were also outlined and explained. Early phase throwing mechanics vs late phase throwing mechanics were then analyzed in context of these patterns for both the right and left handed thrower.

Testing parameters, mechanical tendencies and treatment guidelines were offered for each of the three identified rotational patterns. From there, training recommendations were provided, depending on when the throwing mechanics tend to break down. Training activities were provided for faulty early phase throwing for the right hander, late phase throwing for the right hander, early phase throwing for the left hander and late phase throwing for the left hander.

All in all, it was a great weekend of working with my good friend and colleague Allen Gruver on enhancing both throwing and hitting performance using principles of respiration, neurology and sound movement mechanics. The attendees all seemed to appreciate the opportunity to learn and practice all of our testing, treatment and training ideas for the right and left handed baseball athlete.

We are excited to announce and congratulate the Postural Restoration Trained (PRT) Class of 2016! PRT is the result of completing multiple advanced PRI courses, demonstrating a thorough understanding of the science through completion of the PRT application, and successfully participating in practical and analytical testing. Ten individuals earned the designation of Postural Restoration Trained (PRT) under the direction of Ron Hruska, Michael Mullin and Jennifer Platt.

The Postural Restoration Institute® established this credentialing process in 2011 as a way to recognize and identify individuals with advanced training, extraordinary interest and devotion to the science of postural adaptations, asymmetrical patterns and the influence of polyarticular chains of muscles on the human body as defined by the Postural Restoration Institute®. The PRT credential is available to Certified Athletic Trainers, Certified Athletic Therapists and Certified Strength and Conditioning Specialists who have completed the course requirements, application and testing process. With the addition of this class, there are now 33 PRT professionals throughout the U.S.

PRT credentialed athletic trainers and strength and conditioning specialists offer a unique approach to physical medicine and fitness called Postural Restoration. This approach addresses underlying biomechanics which can often lead to symptoms of pain and dysfunction. All mechanical influences on the body that restrict movement and contribute to improper joint and muscle position are considered, examined, and assessed. Techniques are utilized to restore proper alignment of the body while proper respiratory dynamics are considered. Management encompasses prevention and lifetime integration for long-term successful outcomes.

Fitting a bite splint to achieve its original design requires attention to how the splint fits over the teeth it engages - as well as the opposing row of teeth. This installation shows some postural concepts in positioning the patient within the dental chair to optimally improve the cranio-cervical relationship prior to adapting the maxillary-mandibular relationship.

Happy New Year from Japan! Did you know that New Year's in Japan is much like Thanksgiving in the U.S.? All the family members get together, eat and drink all day...the best time of the year!

Anyways, I just wanted to share some photos from the two Myokinematic Restoration courses (Dec 19-20 in Tokyo, Dec 26-27 in Osaka) that Kenny and I taught in Japan. We had two super-hard-working groups of clinicians who were willing to take this intense course even during the holiday season (some of you may have heard, but when we open the registration, these courses were filled in a few hours - wow!). They were dedicated learners - highly engaging, thinking critically and asked tons of great questions. We are proud and excited to add 45 (Tokyo, middle pic) and 41 (Osaka, bottom pic) new members to our PRI Family!

We will continue to offer Myokin courses at various sites in Japan (Nagoya, Tokyo and Fukuoka) this Spring/early Summer, hoping to start offering Postural Respiration courses by the end of this year. If you are fluent in Japanese (because who isn't?), please check our PRI Japan Facebook page for ongoing communications. PRI continues to grow in Japan in 2016...it'll be a great year!